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APPLICATION - SITE APPROVAL <br /> 14. SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> Describe any items of historical or archaeological interest on-site e. .cemeteries or structures): <br /> None <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise,heavy equipment,etc. : <br /> Traffic noise from Jack Tone Road. Farming equipment used on the small orchard(2.2 acres+/-). <br /> Describe any on-site or off-site sources of light of glare(e.g.parkinglot lighting,or reflective materials used): <br /> Headlights from vehicles on Jack Tone Road. <br /> Describe any on-site or off-site source of odor e. .agricultural wastes): <br /> None <br /> Describe any displacement of people that will be caused by the prpject e. .numbers of people,housing units): <br /> None <br /> AUTHORIZATION .SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT,MAY FILE AN APPLICATION. <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> employees from any claim, action or proceeding against the County arising from the Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> ® Legal property owner(owner includes partner, trustee,trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> ❑ Legal agent(attach proof of the owner's consent to the application of the property's involved in this <br /> application and have been authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. <br /> Print Name: r� �iP✓% � „/, �� Signature: � Date: _� 4 <br /> Print Name: Signature: , Date: <br /> Print Name: _ Signature: _ Date.- <br /> Print <br /> ate:Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\DEVSVC\Planning Application Forms\Site Approval.(Revised 02-03-10) Page 5 of 9 <br />